UN Condemns “Normalization” Surgery for Intersexuality

The United Nations Special Rapporteur on Torture (SRT) just released a statement condemning the medical profession’s nonconsensual treatment of intersexuality. Although intersexuality—which surfaces as “ambiguous” external genitalia, sexual organs and/or as sex chromosomes that deviate from normative expectations—rarely poses a health threat, the medical profession continues to perform irreversible surgeries on babies and young children to “normalize” genitalia under the guise that these procedures will save one from enduring a life full of shame living in their “abnormal” body.

Given that the SRT is responsible for investigating and reporting to the UN on questions of human torture, it is telling that these medical practices are being recognized under such purview. The SRT’s powerful position throughout the world leaves us optimistic that these surgeries will get the public criticism they desperately need.

Committed to human rights, the SRT invited Advocates for Informed Choice (AIC), a leader in the fight for intersex rights, to testify on the medical treatment of intersex. The hearings resulted in the SRT’s formal stance against irreversible, involuntary and nonconsensual medical interventions. To quote the SRT’s report, “These [genital-normalizing surgeries] are rarely medically necessary, can cause scarring, loss of sexual sensation, pain, incontinence and lifelong depression and have also been criticized as being unscientific, potentially harmful and contributing to stigma.” AIC’s Executive Director, Anne Tamar-Mattis, described this recognition as “a very significant development.”

While this is progress for the intersex community, there are still some serious roadblocks to overcome for social change to occur.

One of the reasons why these irreversible surgical interventions continue is because the “diagnosis” is presented as a medical “emergency” to the parents of babies and young children with intersex traits. By constructing intersex traits as medical emergencies, medical providers create an urgent problem that only they can solve. The process begins with a wild goose chase for medical markers of one’s “true” sex, despite the difficulties of such a task given that there are few, if any, clear markers of sex. After the medical providers have crafted their best guess of one’s “true” sex, irreversible treatments are recommended to parents. In response, parents usually offer their consent to the suggested medical interventions because, like most of us, they defer to medical expertise.

Another reason these medically unnecessary surgeries continue is that parents rarely, if ever, are told that these irreversible interventions are almost always cosmetic and can result in loss of sexual pleasure, feelings of abnormality and even emotional harm. We doubt parents would consent to such elective procedures if they knew these dangerous outcomes. This is hardly informed consent.

Until the medical profession acknowledges that intersex traits are not abnormalities that need to be fixed, but rather a naturally occurring variation, surgeries will continue. We aren’t suggesting medical providers are evil people. Their intentions may be in the right place, but their surgical responses are not. The medical profession must recognize that genitals are not one-size-fits-all. Vaginas vary in appearance. So do penises. Intersex traits are not abnormalities but part of the larger picture of sex variance.

As feminist scholars have suggested before, we need to radically reorient the discussion around the socially constructed nature of gender and sex and foster a politics of belonging, where such variations are valued rather than surgically erased.

Intersexuality is hardly ever a medical concern. If we want to improve the lives of those born with intersex traits, we should begin by acknowledging how diverse all bodies, genitals included, actually are. We suspect such a project would be liberating for all of us regardless of our genital appearance.

Comments

It’s good to see that intersex is finally being seen as a human rights abuse.
The more coverage there is about intersex variations the better. It would be
wonderful though if this article did not continue to refer to us-those with intersex
variations-as ‘intersexuals’…we are people who either identify as intersex or people
with intersex variations. To call us ‘intersexuals’ simply confuses people who aren’t able to
separate physiological sex from gender identity. Thanks.

It’s good that Intersex/DSD people are finally being recognized. What pisses me off as an Intersex/DSD person is when the article refers intersex/DSD people as ‘Intersexuals’. It confuses people who can’t separate physiological sex from gender identity. It also pisses off Intersex/DSD people because their is nothing sexual about being born with a Intersex/DSD condition. It’s wrong to call Intersex/DSD people ‘Intersexual’ and I think that word should be stricken out.

Not necessarily. Particularly since the person you’re commenting on actually is intersex and would know better than you whether DSD is a harmful term or not. Certain gender-related abnormalities can be called disorders. Disorder can apply to physiology in two ways. A disease being “an abnormal condition affecting the body of an organism” and a mental disorder being “a psychological pattern or anomaly, potentially reflected in behavior”. Being born with multiple sexes is a physical disorder because it’s an abnormal condition. Being transgender is a mental disorder because it’s an anomaly as well. There’s no need to attach extra baggage to it.

Normally people are born with one sex, and normally that sex matches their internal gender. Sometimes it doesn’t, and when it doesn’t it should be treated according to the person’s will. If they want to keep multiple sexes they can, if they want to change to one or the other, they should be able to pick which one. If they’re born with one sex but identify differently and want to change that, they should be able to do that also.

Not classifying it as a disorder is just as well claiming it isn’t really a problem for that individual and to treat it is ‘cosmetic’ and not a medical necessity, which it IS. People with gender dysphoria are often high-risk for depression and suicide and should be treated medically with gender reassignment if that’s what they desire.

(Could be misunderstanding, but) I think the point in not calling it a disorder is that we are collectively saying, as a society, “We accept you for how you were born. It is natural and OK.” Not every Intersex person has dysphoria and not everyone with dysphoria is intersex. Being intersex doesn’t have to mean that someone is disordered/ has anything wrong with them or feels negatively. Saying disorder implies a fault, or that something ought to be changed/ fixed, whereas in this case, being intersex does not mean anything needs to be changed about an individual.

Seeing as the UN is an international body, and the intersex scholarship movement is an international one, it behooves you to work a little harder at locating international scholarship that has brought us here along with the American work and grass-roots organizing. You should be looking at the information released from the 2nd Intersex Forum held in Stockholm Dec 9-11, 2012 and the statement we released through ILGA. You should be looking at the collection “Critical Intersex” (Ashgate Press, 2010) that includes scholarship from Germany, the Netherlands, the UK, and North America. You should be mentioning the work of OII (with locations and activists around the world). You might want to talk about the testimony provided by Vincent Guillot to the EU commission in Luxembourg last year. You might want to take a look at my book, “Intersex: A Perilous Difference” (Susquehanna UP, 2008). Perhaps you should read the entire Cardozo Journal of Gender and Law (2006) devoted to the problems with how medicine treats intersex. Without this work, what has followed from it would not be possible.

Dr. Morgan Holmes,
While I appreciate your alledged expertise in this area, I find your harsh tone off-putting. You do not give uninformed readers, such as myself, any concrete comments informing us as to what exactly you find offensive in the MS. author’s posting. This is very disturbing and completely undermines the cause you are seemingly promoting. We are left clueless, unless willing to take precious time ourselves to follow your research crumb trail. I find this offensive, frankly. What exactly is your view, since you clearly feel it is far superior to this writer’s?
Dr. Melissa Keith

This is yet again one of those tone arguments. Morgan Holmes is pointing at something that is most relevant, and that is to acknowledge the importance and role of intersex people’s own voices in achieving this goal. Solely stating that feminists scholars are responsible of it, the authors on this article erase – albeit unconsciously – our own subjectivities/agentivity. And it cannot be said that this is a new «lesson». This has happened or happens to every single oppressed/marginalized group there was/is. The dominant group’s attention is focused on its own voices, giving credit to saviors in its midst and forgetting/neglecting to value and acknowledge the oppressed member’s crucial reflexions and actions.

Ouch. As a professor myself, reading your comment made me cringe with secondhand embarrassment. But I decided to give you the benefit of the doubt and assume that you just copied-and-pasted that paragraph from elsewhere… Possibly some harshly worded feedback you gave to an article that didn’t cite your book? It behooves you to work a little harder at communicating respectfully.

I don’t recall reading that in my copy of the report. Generally speaking people born with Sex Chromosome Aneuploidy do indeed have serious health/education issues. X0 womnen for instance often have heart defects requiring urgent therapy. But it’s a myth to say SCA is intersex or having an SCA requires no therapy.

It is unnescessary surgical intervention that ought to be outlawed, not surgery on infants because a pressure group has a problem understanding what is or is not intersex. SCA is not intersex.

I agree that the article could’ve been clearer about SCA, but the main point that “normalization” operations are unnecessary still stands. The article isn’t about operations for heart defects–it’s about operations to the genital region.

I appreciate all of your comments, and I recognize the importance of thinking outside of the U.S.—especially when it comes to acknowledging the diversity of research and activism around intersex rights.

This topic is very close to me. I was born with an intersex trait, and after years of secrecy, I decided to bridge my personal connection with my professional interests. I touch upon this in a short biographical video I submitted for The Interface Project. It is available here, if you are interested: http://www.youtube.com/watch?v=J73rbcuox34

Thank you again for the feedback. I take all of it very seriously.
Georgiann

I stand corrected and I apologize to you. I normaly have as a principle to be kind to other intersex people and here I presumed you were not. I’m thrilled to see there is another one of us out there in academia! As professors, I know only of Morgan Holmes, Iain Morland (although he unfortunately no longer is), Mauro Cabral and myself. There are also some students to look out for.

Recognizing the role and importance of intersex – or any other oppressed group, for that matter – activists’ voices, actions, and theoretical reflexions (outside as well as inside academia) is very dear to me. Consequently, I am weary of oppressed groups’ contributions and perspectives being unacknowledged or under-acknowledged. I myself have recently been out as intersex and am progressively testing the waters. While first getting involved, I had some good amount of energy and patience in store, but diving into medical discourse or any discourse that presents our existence as some sort of problem has proved more draining than I expected. Getting to know the extent of our erasure makes me hypersensitive to any one of its’ manifestations. All of that considered, however, there remains one dimension on which I am willing to put extra-effort and energy, and that is intersex community building and solidarity.

As a spouse caregiver of an intersex person, this is very good news. The good news about this announcement is something we have always felt based on first-hand experiences and advocated which is to STOP “normalizing surgeries” in intersex people without presenting a scientific basis. I find the current protocol in treating “normalizing” intersex surgeries during a marriage is completely uncalled for. What is the scientific basis for having a “normalizing” intersex surgery of an adult during marriage? I personally know of intersex people well above their 50s and 60s living a happy life WITHOUT any “normalizing surgery”. Let us hope the train of thought of awareness continues.